Living With Brain Injury and the Advantage of the Tutor System

Brain injury is as unpredictable in its consequences. Brain injury may affect who we are and the way we think, act, and feel. It can also change everything about us in a matter of seconds. The most important things that patients, family and educators need to remember:
1. Firstly a person with a brain injury is a person first!
2. Secondly no two brain injuries are exactly the same
3. Thirdly the effects of a brain injury are complex and vary greatly from person to person
4. Fourthly the effects of a brain injury depend on such factors as cause, location, and severity
According to the Centers for Disease Control and Injury Prevention 1.7 million people sustain a traumatic brain injury (TBI) each year with the leading causes of TBI are:
1.  Falls (35.2%)
2. Motor vehicle-traffic crashes (17.3%)
3.  Struck by/against events (16.5%)
4. Assaults (10%)
A Healthy Brain
In order to understand what happens to the brain following injury, we need to understand what a healthy brain is made of and what it does. Firstly, the brain is enclosed inside the skull which acts as a protection to the soft brain tissue. The brain is made of millions of neurons or nerve cells. These neurons carry messages in the form of electrical signals to various parts of the brain. These signals are used as inputs from the periphery and outputs to the periphery in order to perform functions including the corodination of the sympathetic nervous system including breathing, heart rate, body temperature, and metabolism as well as processing; body movements; personality; behavior and information from the senses of vision, hearing, taste, smell, and touch. Each part of the brain is seen to serve a specific function and links with other parts of the brain in order to achieve coordinated and complex functions.
An Injured Brain
A  brain injury affects the function of these neurons they are no longer or in some degree able to carry the messages between different parts of the brain or to and from the peripheral nerves and muscles. This will affect how a brain injury patient thinks, acts, feels, and moves their body.
Functions of the Brain
Lobes are areas of the brain charged with specific function and include the Frontal Lobe, Temporal Lobe, Parietal Lobe, Occipital Lobe, the Cerebellum, and the Brain Stem.
Parietal Lobe Functions
Sense of touch/ Spatial perception/ Differentiation of shapes, size, and colours/ Visual perception
Occipital Lobe Functions
Vision
Cerebellum Lobe Functions
Visual perception/ Coordination/ balance/ Skilled motor activity
Brain Stem Functions
Arousal and consciousness/ breathing/ Sleep and wake cycles/ Attention and concentration/ Heart rate
Frontal Lobe Functions
Planning and anticipation/ Organization/ Motor planning and initiation/ Mental flexibility/ attention and concentration/ Speaking (expressive language)/ Personality/ Self-monitoring/ Awareness of abilities and limitations/ Inhibition of behavior/ Emotions/ Problem solving/ Judgment
Temporal Lobe Functions
Understanding language (receptive language)/ Memory/
Brain Lobesing
Right or Left Brain
The lobes of the brain are also divided into right and left sides with the two sides of the brain being responsible for different functions. with different patterns of dysfunction due to an injury on either the  right or left brain side.
Injuries of the left side of the brain can cause:
Difficulties in speaking or verbal output (expressive language)/ Difficulties in understanding language (receptive language)/ Catastrophic reactions (depression, anxiety)/ verbal memory/ Impaired logic/ Sequencing difficulties/ Decreased control over right-sided body movements
Injuries of the right side of the brain can cause:
Loss of “the big picture” type of thinking/ Visual memory deficits/ Visual-spatial impairment/ Left Neglect/ Decreased awareness of deficits/ Altered creativity and music perception/ Decreased control over left-sided body movements
Impairments due to an injury on both sides of the brain.
Impaired cognitive (thinking) skills in all areas/ Reduction in thinking speed/ Confusion/ Reduced attention and concentration/ Fatigue/
When the brain injury causes impaired movement of upper or lower limbs the Tutor system has demonstrated remarkable improvement when integrated into the post stroke physiotherapy program.
Intensive exercise practice has shown to improve functional movement ability following orthopedic and neurological injury and disease. Patient motivation and control of the exercise practice are the fundamental factors that are required for optimum functional recovery. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to intensive exercise training. In addition low technology tools do not provide sufficient resolution to completely control the required exercise performance.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
 Currently in use in leading U.S. and foreign hospitals and clinics the new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.


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